Activity Title

Program Goals

Two important presentations of central sleep apnea (CSA) are opioid-induced CSA (Op-CSA) and treatment-emergent CSA (TE-CSA). TE-CSA is relatively rare and usually resolves over time. Physicians should be aware of these two important versions of CSA, the similarities and differences in their risk factors, symptoms, disease courses, and treatment recommendations. Importantly, although continuous positive airway pressure (CPAP) should be avoided in patients with Op-CSA, as CPAP may worsen a patient’s sleep disordered breathing, in TE-CSA there is a recommendation for intervening with CPAP, although only with back-up. In both presentations, if CPAP is employed, it should be initiated as bilevel PAP with a back-up rate or if available as adaptive servo-ventilation (ASV). CSA itself represents a poorly understood entity to recognize and treat. At the present time the consensus favors treating the breathing disorder, especially if the patient is symptomatic, based on the limited evidence-base for treating CSA in general. However, although there is a consistency in that the majority of central events tend to occur during NREM, not REM, sleep, other CSA manifestations differ slightly between Op-CSA and TE-CSA and there is an educational need for some knowledge of these differences.

The purpose of this educational activity is to review the proper use of BiPAP with back-up and autoSV for the treatment of sleep disordered breathing, including TE-CSA and Op-CSA. Emphasis will be placed on proper patient and therapy selection, especially in those patients who are opioid users.

Target Audience

This activity is intended for healthcare professionals involved in the management of patients with sleep disordered breathing. This especially applies to the following clinical and research fields: Sleep Medicine, Pulmonary Care Medicine, Sleep Technology, Respiratory Therapy, Nursing and Nurse Practitioners, and Physician Assistants.

Learning Objectives

After completion of this activity, participants should be able to:

Review the similarities and differences in the diagnosis and treatment of Op-CSA versus TE-CSA.

Explain the mechanisms for sleep disordered breathing in patients who use opioids.

Describe the indications for which different forms of positive airway pressure (PAP) intervention are recommended for CSA, TE-CSA, and Op-CSA.

Release and Expiration Dates

Disclosure of Conflicts of Interests

Global Education Group requires instructors, planners, managers and other individuals and their spouse/life partner who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

Faculty Disclosures

The faculty reported the following financial relationship or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Planners and Managers

The planners and managers reported the following financial relationship or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

GLOBAL EDUCATION GROUP / GANESCO, INC.

Ashley Marostica, RN, MSN

Nothing to disclose

Lindsay Borvansky

Nothing to disclose

Andrea Funk

Nothing to disclose

Laura Gilsdorf

Nothing to disclose

Gail Varcelotti, BS, RRT, FAARC

Nothing to disclose

CME Provider Accreditation Statement

This activity is provided by Global Education Group.

Physician Accreditation Statement - CME

Global Education Group is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

*This CME/CE activity complies with all requirements of the federal Physician Payment Sunshine Act. If a reportable event is associated with this activity, the accredited provider managing the program will provide the appropriate physician data to the Open Payments database.

Physician Credit Designation - CME

Global Education Group designates this enduring material for a maximum of 1.75AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Education

Global Education Group is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's COA.

This educational activity for up to 1.75contact hour is provided by Global Education Group. Nurses should claim only the credit commensurate with the extent of their participation in the activity.

Global Education Group

For information about the physician accreditation for this activity, please contact Global Education Group at (303) 395-1782, or inquire@globaleducationgroup.com.

How to Obtain CME/CE Credit

Attendees are expected to view the entire activity before attempting to take the test and/or complete the activity evaluation. Successful completion will lead to the issuance of a certificate for AMA PRA Category 1 Credit™ or nursing credit. To receive credit, the course must be completed between May 8, 2017 and May 8, 2019.

Participation in this activity should be completed in approximately 1.75 hours. Please follow these steps in order to receive CME/CE credit for viewing the webcast:

Read all of the CME/CE accreditation information above.

View the complete electronic (web) activity.

Click on the link to apply for CME/CE credits.

Complete the online registration (registration is free).

Complete the online test and/or evaluation. Participants must receive a test score of at least 75% and answer all evaluation questions to receive a certificate.

After successfully completing the online test and/or evaluation, your application will be immediately processed and you will be given the opportunity to download a personalized CME/CE certificate for participation in this activity.

Should you have any CME/CE questions regarding this activity, please contact:

Credit Designation - CSRT

This educational offering has been approved for 1.75 continuing education credit/professional development credit by the Canadian Society of Respiratory Therapists. Global Education Group (CME provider) maintains all responsibility for this offering and its content. 201-2460 Lancaster Road, Ottawa, ON K1B 4S5

How to obtain CSRT and CRSE Credit

Attendees are expected to review all academic materials before attempting to apply for credit. Successful completion of this activity will lead to the issuance of a certificate for 1.75 contact hour of CRCE and CSRT approved continuing education.

To receive credit, please follow these steps:

Complete the online registration (registration is free).

Review all of the academic materials provided.

Click on the CRCE / CRST link to apply for credit.

Complete the online test and/or evaluation. Participants must receive a test score of at least 70% and answer all evaluation questions to receive a certificate.

Qualified applicants will be provided with an online (printable) CRCE / CSRT certificate based on their attendance and satisfactory completion of this academic activity.

Fee Information

There is no fee for this educational activity.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) does not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Policy on Privacy and Confidentiality

Global Education Group protects the privacy of personal and other information regarding participants, educational partners, and joint sponsors. Global Education Group and our joint sponsors will not release personally identifiable information to a third party without the individual's consent, except such information as is required for reporting purposes to the appropriate accrediting agency.